Ovarian artery aneurysms have rarely been reported in the literature, with almost all being unilateral and occurring in the peripartum period. We herein describe a unique case of a postmenopausal patient with a ruptured ovarian aneurysm and an intact contralateral aneurysm that were both successfully treated by endovascular techniques.
Methods: A consecutive 123 patients who survived proximal AAD surgery were reviewed at a single institution. The medical charts and computed tomography (CT) studies of these patients were reviewed from 2005 to 2014. The short axis area of the true lumen (TL), the false lumen (FL), and the total cross-sectional area were measured from reconstructed images using centerline technique at the largest segment each of the aortic arch, descending thoracic aorta (TA), aorta proximal to the celiac artery, and abdominal aorta. Survival and time to first reoperation were analyzed with Kaplan-Meier and Cox proportional hazards models. Factors associated with radiologic change were evaluated using multiple linear regression models. A significant change was defined as >10% change from the baseline CT angiogram. Results: Mean interval (baseline and the comparison CT scan) was 779 days. At least one sequential CT scan was available for 67 (55%) of the 123 patients (43 male, 34 female; mean age, 59.6 years). In general, the TA and FL increased in size during the study period (Fig; blue, TA; red, FL). Multivariate analysis showed that age >60 years and smoking were significantly associated with an increase in TL over time, whereas coronary artery disease and chronic obstructive pulmonary disease were associated with a decrease in TL (P ¼ .03). Hyperlipidemia and coronary artery disease were associated with an increase in FL size. Pre-existing aortic aneurysm, coronary surgery, and hemodialysis were significant risk factors for reoperations (P ¼ .029). Age >60 years (P ¼ .01), chronic obstructive pulmonary disease (P ¼ .002), and male gender (P ¼ .02) were also associated with an increase in total area, signifying distal aneurysmal progression. Conclusions: Patient risk factors predict unfavorable long-term morphologic outcomes in the remaining aortic tree after AAD surgical repair. These factors should be used as markers to identify patients who may benefit from closer surveillance and possibly earlier endovascular intervention to the distal TA.
Objective:Penetrating carotid trauma in a hemodynamically stable patient invariably presents with a pseudoaneurysm on initial imaging. Although extremely rare, delayed pseudoaneurysm formation has been reported. The purpose of this paper is to define this rare entity and propose a diagnostic and treatment plan.Methods:We present a case of delayed presentation of carotid pseudoaneurysm following penetrating neck trauma. A systematic review of the literature was performed.Results:A 21-year-old male presents to the trauma center after sustaining a gunshot wound to the left upper back resulting in a zone 2 hematoma and pneumothorax. Bullet fragment artifact interfered with computed tomography. Carotid angiogram was normal. The patient was discharged after 3 days. He returned to the Emergency Department 3 months later with a painful pulsatile hematoma. Computed tomography angiogram revealed a 6-cm pseudoaneurysm arising from the proximal left internal carotid artery (ICA). A left common carotid artery (CCA) to ICA bypass with reversed great saphenous vein was performed. The patient’s post-operative course was uneventful, neurologic deficits improved, and he was discharged.Conclusion:Delayed presentation of traumatic pseudoaneurysms has been reported, although usually these cases are iatrogenic access complications in extremities. While endovascular therapies are first line for zone 1 and 3 vascular injuries, management of zone 2 injuries is still controversial. This patient was treated with a bypass due to the need to evacuate the hematoma that was exerting a mass effect in the neck.
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